Editorial Comment

Abstract

Multiparametric magnetic resonance imaging (mpMRI) and fusion-guided biopsy have ushered in a new era in the diagnosis and treatment of prostate cancer. As its current role continues to expand, defining its value among various patient populations has become a primary focus. The present study 1 Abdi H. Pourmalek F. Zargar H. et al. Multiparametric magnetic resonance imaging enhances detection of significant tumor in patients on active surveillance for prostate cancer. Urology. 2015; 85: 423-429 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar adds to the growing body of literature supporting the use of imaging in active surveillance (AS) and its direct impact on patient management. Using a heterogeneous AS population, the authors 1 Abdi H. Pourmalek F. Zargar H. et al. Multiparametric magnetic resonance imaging enhances detection of significant tumor in patients on active surveillance for prostate cancer. Urology. 2015; 85: 423-429 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar used a clinically relevant endpoint—the termination of AS—to gauge the impact of mpMRI on treatment decision making. Of 111 patients undergoing mpMRI, 24.3% subsequently sought active treatment, of which 63% were based on imaging findings alone. An important endpoint is also pathologic progression. The subgroup analysis of 97 patients with an initial Gleason score of ≤6 demonstrated progression to a Gleason score ≥7 in 30.6% of patients. This echoes recent findings of the University of Toronto group revealing progression in 26% of patients and established a negative predictive value of 100% for mpMRI in ruling out a Gleason score ≥7 disease. 2 Da Rosa M.R. Milot L. Sugar L. et al. A prospective comparison of MRI-US fused targeted biopsy versus systematic ultrasound-guided biopsy for detecting clinically significant prostate cancer in patients on active surveillance. J Magn Reson Imaging. 2015; 41: 220-225 Crossref PubMed Scopus (78) Google Scholar Multiparametric Magnetic Resonance Imaging Enhances Detection of Significant Tumor in Patients on Active Surveillance for Prostate CancerUrologyVol. 85Issue 2PreviewTo determine whether multiparametric magnetic resonance imaging (MRI) of the prostate (mpMRI) combined with MRI fusion technology during transrectal ultrasound-guided biopsy can enhance the detection of significant disease in patients with apparent low-risk prostate cancer on active surveillance (AS). Full-Text PDF ReplyUrologyVol. 85Issue 2PreviewWe share in the growing enthusiasm for multiparametric magnetic resonance imaging (mpMRI) in the management of patients on active surveillance but recognize also that there are still many obstacles in demonstrating its clinical utility. Ideally, studies like our own will be validated in prospective trials, and the holy grail of mpMRI is to demonstrate that a simple scan can replace biopsies in men on active surveillance. Because the most relevant clinical endpoints (metastasis-free and overall survival) require >10 years to reach, it will be challenging to address this clinical need. Full-Text PDF